Updated July 18, 2006

Oral Medicines for Type 2 Diabetes

by Patti Geil, M.S., R.D., C.D.E., and Laura Hieronymus, M.S.Ed., A.P.R.N., B.C.-A.D.M., C.D.E.

During pregnancy, insulin has always been the treatment of choice for diabetes because oral medicines have long been thought to increase the risk of damage to the fetus. However, research into certain oral medicines (particularly glyburide and metformin) has led to their consideration as treatment for gestational diabetes and Type 2 diabetes during pregnancy. This is an area of controversy, however, and one in which a woman and her health-care team have to carefully weigh the risks and benefits together.

Getting the most from your medicines
Caring for your diabetes requires attention to detail in many areas, from meal planning to physical activity to monitoring of blood glucose. With everything else to consider, it’s no surprise that some people occasionally forget to take their oral medicines. In fact, research shows that nearly one in three people with Type 2 diabetes who need oral medicines fail to take them daily. Unfortunately, this doubles the likelihood of hospitalizations for heart- or diabetes-related complications.

What should you do if you forget to take your diabetes pill or pills? As a general rule, you can take a missed dose of medicine as soon as you remember it. However, if it is almost time for your next scheduled dose, you may be advised to skip the missed dose and go back to your regular schedule. Do not take a double dose. Taking a missed dose of repaglinide or nateglinide between meals could result in hypoglycemia because these drugs stimulate the release of insulin from the pancreas. If you miss a dose of acarbose or miglitol, taking it between meals will have little effect, because its action is based on stopping the absorption of carbohydrate after eating. Instead, resume taking it at your next meal.

Treating diabetes is an art grounded in science. Work with your diabetes team to choose and use the oral medicine or combination of oral medicines that works best for your situation. You may want to consider the cost of the drug and the number of times per day you have to take it, as well as side effects and possible interactions with any other drugs you may take. Fortunately, today’s diabetes toolbox is well stocked with options to help you reach your blood glucose targets!

Patti Geil and Laura Hieronymus are certified diabetes educators and diabetes health consultants in Lexington, Kentucky. They are part of the education team at an American Diabetes Association–recognized education service at Drs. Borders & Associates, PSC. The authors gratefully acknowledge the expertise and contribution of their colleague, Stacy Griffin, Pharm.D., R.Ph.

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